J Korean Orthop Assoc.  2008 Feb;43(1):30-35. 10.4055/jkoa.2008.43.1.30.

Comparison of Flexible Intramedullary Nailing with External Fixation in Pediatric Femoral Shaft Fractures

• Kim DY
• Shin SR
• Jeong US
• Park YW
• Lee SS
• Park KM

• KMID: 2106413
• DOI: http://doi.org/10.4055/jkoa.2008.43.1.30

Abstract

PURPOSE: This study compared the results of external fixation with those of flexible intramedullary nailing using Ender nails in pediatric femoral shaft fractures.
MATERIALS AND METHODS
Twenty-eight children with pediatric femoral shaft fractures were enrolled in the study. The children's ages ranged from 6 to 11 years, and the average period of follow-up was 27.2 months. Fifteen patients underwent flexible intramedullary nailing (FIN) using Ender nails and thirteen patients underwent external fixation (EF). The outcomes were assessed based on the clinical and radiology findings.
RESULTS
The healing time averaged 9.8 weeks in the FIN group and 11.2 weeks in the EF group. In the FIN group, one patient suffered pin migration. In the EF group, three patients had a pin site infection, one patient had refracture after removing the external fixator and one patient had pin breakage 8 weeks after surgery. The broken pin was removed and the condition was stabilized with internal fixation using a plate.
CONCLUSION
Flexible intramedullary nailing with Ender nails is an effective treatment option for treating femoral shaft fractures in children because it has fewer complications than external fixation does.

Keyword

Pediatric femoral shaft fracture; Flexible intramedullary nailing; External fixation

MeSH Terms

Child
External Fixators
Follow-Up Studies
Fracture Fixation, Intramedullary
Humans
Nails

Figure

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  Fig. 1 (A) Preoperative AP and lateral radiographs of a 9-year-old girl shows a transverse fracture of the middle one-third of the femur. (B) Postoperative 9 week radiographs shows good union with Ender nails.

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  Fig. 2 (A) Postoperative 10 week radiographs in a 9-year-old boy treated with external fixation show good union. (B) A refracture occurred 3 weeks after removing the external fixator. (C) Radiographs taken 6 months after internal fixation with a plate show complete bony union.

Reference

1. Aronson J, Tursky EA. External fixation of femur fracture in children. J Pediatr Orthop. 1992. 12:157–163.

2. Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study. J Bone Joint Surg Br. 1997. 79:975–978.

3. Carey TP, Galpin RD. Flexible intramedullary nail fixation of paediatric femoral fracture. Clin Orthop Relat Res. 1996. 332:110–118.

4. Corry IS, Nicol RO. Limb length after fracture of the femoral shaft in children. J Pediatr Orthop. 1995. 15:217–219.

5. Gregory RJ, Cubison TC, Pinder IM, Smith SR. External fixation of lower limb fractures in children. J Trauma. 1992. 33:691–693.

6. Evanoff M, Strong ML, MacIntosh R. External fixation mainiained until fracture consolidation in the skeletally immature. J Pediatr Orthop. 1993. 13:98–101.

7. Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures: a multicerter study of early results with analysis of complications. J Pediatr Orthop. 2001. 21:4–8.

8. Flynn JM, Luedtke LM, Ganley TJ, et al. Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am. 2004. 86:770–777.

9. Hansen TB. Fractures of the femoral shaft in children treated with an AO-compression plate: Report of 12 cases followed until adulthood. Acta Orthop Scand. 1992. 63:50–52.

10. Heinrich SD, Drvaric DM, Darr K, MacEwen GD. The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: a prospective analysis. J Pediatr Orthop. 1994. 14:501–507.

11. Hong KD, Ha SS, Chung NS, Sim JC, Kim JY. Nancy nail fixation for femur shaft fracture in children. J Korean Fracture Soc. 2003. 16:592–599.

12. Kim HY, Park JH, Lee SH, et al. Treatment of femoral shaft fractures with external fixators in children. J Korean Fracture Soc. 2002. 15:36–44.

13. Ligier JN, Metaizeau JP, Prevot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg Br. 1988. 70:74–77.

14. McCartney D, Hinton A, Heinrich SD. Operative stabilization of pediatric femur fractures. Orthop Clin North Am. 1994. 25:635–650.

15. Yun YH, Choi CH, Jung JH. Flexible intramedullary nailing in children's femoral shaft fractures. J Korean Fracture Soc. 2003. 16:385–391.